What are preventive health services?
Preventive health services help people stay healthy and detect health problems early. Preventive care includes services like wellness visits, immunizations, contraceptive services, and cancer screenings. Specific services recommended by expert committees must be provided at no cost to the patient. This means that even if a patient has not met their plan deductible or out-of-pocket limits, their health insurance should still cover the full cost of these services without requiring the patient to pay a deductible, co-insurance or co-payment. The list of preventive services for adults, women, and children that should be provided at no cost is available on HealthCare.gov.
Who determines which services qualify as no-cost preventive care?
The list of preventive services is based on recommendations from the United States Preventive Services Task Force (USPSTF), the Health Resources and Services Administration (HRSA), and the Advisory Committee on Immunization Practices (ACIP).
How much do preventive health services cost?
Even though patients should not have to pay anything for covered preventive services, insurers must still cover the cost of these services. The price of each preventive service is the total amount paid by insurance for the service and represents what patients could pay if the service no longer qualified as no-cost preventive care.
Use the table below to find the price of selected preventive services. The list below includes some of the most commonly used services but is not a comprehensive list of all services we identify as preventive. For a full list, please refer to the methods section. Note that these prices represent the average prices of each service across different settings (e.g. outpatient and office), and previous research shows that the price of services can vary by site of service.
Methods
The preventive services included in our analysis were selected from multiple sources, including a previous paper that examined out-of-pocket costs for preventive care, along with updated guidelines from the USPSTF and HRSA. Our analysis included some covered prescription drugs, including contraceptives and PrEP, that were not included in the paper. We used the same broad ‘All preventive services’ methodology outlined in the paper to identify claims for preventive services. We included claims that occurred in an outpatient or office setting and did not restrict claims to the first occurrence of the service per person per year. For contraceptive services, we included claims that had either a procedure code or diagnosis code from the list. For breast cancer screening and tobacco counseling, we included claims that had a procedure code from the list. For all other services we required claims to have both a diagnosis code and procedure code from the list. We restricted claims for some service categories by age and sex based on USPSTF, HRSA and ACIP guidelines, as shown in the table below:
| Service | Age Group | Sex |
| Alcohol Misuse Counseling | 18+ years | All |
| Bacteriuria Screening | All | Females |
| Breast Cancer Counseling | All | Females |
| Breast Cancer Screening | 35+ years | Females |
| Breastfeeding Support | All | Females |
| Cervical Cancer Screening | 18+ years | Females |
| Colorectal Cancer Screening | 45+ years | All |
| Diabetes Screening | 35+ years | All |
| Hepatitis C Screening | 18+ years | All |
| Pregnancy Related Screenings | All | Females |
| Lead Screening | <18 years | All |
| Newborn Blood Spot Screening | <18 years | All |
| Newborn Gonorrhea Screening | <18 years | All |
| Newborn Metabolic Screening | <18 years | All |
| Vision Screening | <18 years | All |
| Lung Cancer Screening | 45+ years | All |
We excluded claims for enrollees who were not enrolled in an ESI plan or did not have prescription drug coverage at the time of service. We also excluded claims where the ESI health plan was not the primary payer (e.g. claims covered by workers’ compensation).
Average prices were calculated by dividing the total spending for each procedure code or standardized 30-day supply of medication (NDC code) and dividing by the service count (for procedure codes: count of distinct patient ID and service date combinations; for NDC codes: count of 30-day standardized fills). Note that average price calculations at the procedure level only include costs for the individual procedure code, and not related ancillary services (e.g., labs, anesthesia, etc.).